Mkt Manager Revenue Cycle
CHI Saint Joseph Medical Group now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health includes 275 providers delivering quality care to patients across 88 locations in central and eastern Kentucky. Our full service network delivers a variety of Primary Care Services including Family Internal Geriatric and Pediatric Medicine in addition to several specialties to deliver custom care based on the unique needs of our patients.
This job is responsible for planning, supervising and evaluating the daily operations of the assigned business office/revenue cycle function(s) in accordance with established business objectives and applicable regulatory requirements. An incumbent continuously monitors workqueue volumes and productivity as well as the accuracy and timeliness of work results to ensure compliance with internal policies/procedures and customer satisfaction standards. Work is also strongly focused on developing and maintaining strong relationships with clinic leadership/staff and providers to foster effective two-way communication/feedback and provide guidance/training to improve revenue cycle processes and results.
Work also includes: 1) supervising assigned staff (e.g. hiring, training, scheduling and evaluating) engaged in one or more revenue cycle functions, including claims processing, clinic customer service, charge capture/cash posting, refunds/credits, insurance follow-up and/or related activities in accordance with established operating standards; 2) serving as critical conduit/liaison with various internal departments/external payers to coordinate and/or troubleshoot various revenue cycle-related issues; 3) applying solid critical thinking skills to troubleshooting, problem-solving, resolving errors/problems and appropriate escalation of issues to higher-level management; and 4) identifying opportunities to streamline current operations, implementing approved procedural/process changes, and maintaining/updating guidelines, tools and related materials specific to assigned revenue cycle function.
Work is performed in accordance with established standards/guidelines and requires knowledge of applicable regulatory requirements sufficient to ensure compliant operations and to exercise judgment and critical thinking in addressing operational and/or regulatory issues. Also requires expertise in supervising and evaluating the work of support staff. An incumbent works with higher level management on major operational or business decisions prior to implementation.
Essential Job Duties:
Supervises and evaluates the daily operations of assigned support functions (including claims processing, clinic customer service, charge capture/cash posting, refunds/credits, insurance follow-up, etc.) to ensure that all activities are conducted in a timely and cost-effective manner and in accordance with professional standards, budget constraints, internal policies/standards/procedures and/or applicable legal/regulatory requirements.
- Implements and enforces quality control/quality assurance and productivity standards; ensures that applicable standards, systems and procedures are understood and followed; monitors and audits related documentation to ensure conformance with established standards relating to timeliness and accuracy; prepares periodic productivity reports and program updates for review of higher-level authority.
- Researches inquiries, complaints and requests by internal/external customers and takes appropriate steps to resolve errors or issues; communicates resolution to all interested parties.
- Participates in the development of, and implements, new/revised guidelines, procedures, processes and/or training materials in support of assigned function/work unit to facilitate regulatory compliance and maximize revenues; ensures that employees understand and apply internal guidelines appropriately.
- Reviews and approves voided transactions, adjustments, corrections, write-offs and other revenue cycle actions that are outside the parameters of standard procedures.
Schedules, supervises and evaluates the work of assigned revenue cycle staff in accordance with established standards and procedures; assists in identifying adequate staffing levels for appropriate coverage to meet budgetary and operational objectives.
- Interviews job candidates and makes employment and other staff-related recommendations; ensures that staff are qualified and properly trained to perform assigned job duties.
- Orients/trains employees and holds regular staff meetings to keep employees appraised of all matters relevant to successful job performance; approves timecards and time off requests.
- Communicates performance standards and evaluates employee performance; counsels employees, providing constructive feedback and recognizing results achieved; participates in performance management activities as required.
- Addresses and resolves technical issues referred by subordinates as beyond their scope of authority.
Monitors and assesses current operations/services to identify performance/process improvement opportunities.
- Provides recommendations to Manager for performance/process improvements initiatives; implements approved changes and ensures that staff receive the necessary on-the-job training to enhance their understanding of performance improvement initiatives.
- Monitors staff errors and overall productivity, identifies trends and retrains as necessary to improve performance/results.
- Participates in revenue cycle/business planning activities, including the development/implementation of work unit objectives/projects to address current and future needs to support achievement of business objectives.
Monitors compliance with applicable internal/external legal and regulatory agreements, standards and requirements; takes appropriate steps to address and resolve non-compliance issues within position scope of authority.
- Conducts regular and impromptu account audits to validate accuracy and adherence to organizational standards and procedures; recommends process improvements and/or solutions for areas of deficiency.
- Keeps abreast of changing regulatory requirements/regulations and competitive industry practices impacting assigned functions, as well as organizational initiatives/changes with potential to impact current operations.
- Monitors impact on existing activities and identifies/implements effective response/solution while maintaining acceptable service levels and work quality.
Establishes and maintains professional and effective relationships with peers, payers, patients and other stakeholders; serves as liaison with various internal departments/staff/providers in coordinating and troubleshooting various revenue cycle-related issues.
- Establishes and maintains a professional relationship with clinics and FMG staff in order to resolve issues.
- Promotes an atmosphere of collaboration so all parties feel comfortable approaching with issues and challenges specific to their payer or specialty.
- Acts as a liaison between the assigned revenue cycle function and the Clinics to maintain business continuity and ensure policy and procedure compliance.
Performs related duties as required.
Four years of related work experience that demonstrates attainment of the requisite job knowledge/abilities, including one year in a “Lead” or supervisory capacity.
Associate degree in business administration, medical billing, coding or related field is preferred.
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